Student Enrollment Form

Begin your journey of Islamic learning with us

Personal Information

First Name *

Last Name *

Date of Birth *

Gender *

Contact Information

Email Address *

Phone Number *

Address *

City *

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Course Selection

Course Type *

Package *

Preferred Start Date *

Preferred Time Zone *

Guardian Information (if student is under 18)

Guardian Name

Guardian Phone

Guardian Email

Additional Information

Current Knowledge Level

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Special Requirements or Notes

I agree to the Terms and Conditions and Privacy Policy. I understand that enrollment is subject to availability and confirmation from Safa Institute. *

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